Question 23410 VERSUS 23412

[swallace1]

Can anyone provide insight on when to bill Rotator cuff surgery, open; acute CPT 23410 versus Rotator cuff surgery, open; chronic CPT 23412? Our practice deals with a lot of workers compensation injury patients. Information I have reviewed so far, states- injury is considered acute, regardless of how long-ago injury happened. I am confused on the CPT code assignment of acute versus chronic. Couldn't find any CPT Assistant reference that stated when you would use one over the other. I would be eternally grateful for any suggestions. I have an OP report where physician doesn't state acute or chronic and the coder wants to assign the CPT code for Acute.

 

[amyjph]

If the physician doesn't state, they have to be queried to specify. The codes require that this is specifically documented as to which. What was the diagnosis documented as?
If the injury was acute at the time of injury and it is WC, there may be situations where you would use the S diagnosis and the 23410 regardless of how much time has passed since that was the injury. However, there can be cases where a chronic one would be covered as well depending on the WC situation.

The provider must specify. You can't just assume if it is unclear. Send it back to the provider.

In "general" work comp is going to be 23410. There can always be exceptions though.

 

[swallace1]

Thanks, I appreciate the clarification.